Muscle mass evaluation using psoas muscle mass index by computed tomography imaging in hemodialysis patients

K, Ito; Ookawara, Susumu; Imai, Sojiro; Kakuda, Hideo; Bandai, Yusaku; Fueki, Mariko; Yasuda, Masatoshi; Kamimura, Tatsuya; Kiryu, Satoshi; Wada, Noriko; Hamashima, Yuri; Shindo, Mitsutoshi; Kobayashi, Tadanao; Sanayama, Hidenori; Kaku, Yoshio; Tanno, Keisuke; Ohnishi, Yasushi; Iino, Noriaki; Dezaki, Katsuya; Kakei, Masafumi; Tabei, Kaoru; Morishita, Yoshiyuki

doi:10.1016/j.clnesp.2021.04.029

Cited by 11 publications

(16 citation statements)

References 19 publications

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“…We propose that the loss of skeletal muscle mass plays a major role in the occurrence of aspiration pneumonia. The correlation between low PMI and pneumonia noted in this study along with PMI’s known association with skeletal muscle mass [ 16 , 23 ] corroborates the close association of skeletal muscle mass with pneumonia development in HD patients.…”

Section: Discussionsupporting

confidence: 81%

“…Dual-energy X-ray absorptiometry and bioelectrical impedance analysis are the gold standards for accurately evaluating muscle mass [ 8 , 21 ]; however, these methods are not readily available at HD facilities. CT-based evaluation of the psoas muscle cross-sectional area and subsequent calculation of PMI has shown good inter-rater reliability [ 16 , 22 ]. Furthermore, PMI correlated with the skeletal muscle mass in dialysis patients [ 16 , 23 ].…”

Section: Discussionmentioning

confidence: 99%

“…CT-based evaluation of the psoas muscle cross-sectional area and subsequent calculation of PMI has shown good inter-rater reliability [ 16 , 22 ]. Furthermore, PMI correlated with the skeletal muscle mass in dialysis patients [ 16 , 23 ]. Therefore, annual CT scans performed to detect acquired cystic and malignant kidney disease are useful for HD patients [ 23 , 24 ] and may be utilized for the assessment of trunk muscle mass.…”

Section: Discussionmentioning

confidence: 99%

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Association between the psoas muscle index and hospitalization for pneumonia in patients undergoing hemodialysis

et al. 2021

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Background Although muscle mass loss and pneumonia are common and crucial issues in hemodialysis (HD) patients, few reports have focused on their association, which remains unclear. This study assessed the association between skeletal muscle mass and the incidence of pneumonia in HD patients using the psoas muscle index (PMI). Methods This retrospective study included 330 patients on HD who were treated at a single center between July 2011 and June 2012. The observation period was between July 2011 and June 2021. Demographic, clinical, and HD data were collected, and the associations between PMI and hospitalization due to bacterial pneumonia were evaluated using Cox proportional hazards models adjusted for patients’ background data. Additionally, the correlation between patient characteristics and PMI was evaluated using multivariable linear regression. Results Among 330 patients (mean age, 67.3 ± 13.3; 56.7% male; median dialysis vintage 58 months, (interquartile range [IQR] 23–124), 79 were hospitalized for pneumonia during the observation period (median observation period was 4.5 years [IQR 2.0–9.1]). The multivariable Cox proportional analysis, which was adjusted for age, sex, dialysis vintage, diabetes mellitus, and stroke history and considered death as a competing risk, indicated that decreased PMI/(standard deviation) was closely associated with the development of pneumonia (hazard ratio: 0.67, 95% confidence interval: 0.47–0.95, p = 0.03). Conclusions Skeletal muscle mass was associated with the development of pneumonia in patients on HD and could be a useful marker for the risk of pneumonia.

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Section: Discussionsupporting

confidence: 81%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Association between the psoas muscle index and hospitalization for pneumonia in patients undergoing hemodialysis

et al. 2021

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“…Analysis of a single abdominal CT section at the L3 level has been most frequently performed, 21 and CT‐assessed L3 SMD has been increasingly recognized as a predictor of mortality in patients with cancer 4–6 and non‐cancer diseases 7,8 . In the dialysis population, previous studies also mainly used CT images at the L3 level 16,17,28 . Due to the high morbidity of infection and heart and lung disease in dialysis patients, 29 chest CT is commonly employed.…”

Section: Discussionmentioning

confidence: 99%

Computed tomography‐determined skeletal muscle density predicts 3‐year mortality in initial‐dialysis patients in China

Sheng,

Cao,

Hou

et al. 2023

J cachexia sarcopenia muscle

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BackgroundSkeletal muscle mass and quality assessed by computed tomography (CT) images of the third lumbar vertebra (L3) level have been established as risk factors for poor clinical outcomes in several illnesses, but the relevance for dialysis patients is unclear. A few studies have suggested a correlation between CT‐determined skeletal muscle mass and quality at the first lumbar vertebra (L1) level and adverse outcomes. Generally, chest CT does not reach beyond L1. We aimed to determine whether opportunistic CT scan (chest CT)‐determined skeletal muscle mass and quality at L1 are associated with mortality in initial‐dialysis patients.MethodsThis 3‐year multicentric retrospective study included initial‐dialysis patients from four centres between 2014 and 2017 in China. Unenhanced CT images of the L1 and L3 levels were obtained to assess skeletal muscle mass [by skeletal muscle index, (SMI), cm2/m2] and quality [by skeletal muscle density (SMD), HU]. Skeletal muscle measures at L1 were compared with those at L3. The sex‐specific optimal cutoff values of L1 SMI and L1 SMD were determined in relation to all‐cause mortality. The outcomes were all‐cause death and cardiac death. Cox regression models were applied to investigate the risk factors for death.ResultsA total of 485 patients were enrolled, of whom 257 had both L1 and L3 images. Pearson's correlation coefficient between L1 and L3 SMI was 0.84 (P < 0.001), and that between L1 and L3 SMD was 0.90 (P < 0.001). No significant association between L1 SMI and mortality was observed (P > 0.05). Low L1 SMD (n = 280, 57.73%) was diagnosed based on the optimal cutoff value (<39.56 HU for males and <33.06 HU for females). Multivariate regression analysis revealed that the low L1 SMD group had higher risks of all‐cause death (hazard ratio 1.80; 95% confidence interval 1.05–3.11, P = 0.034) and cardiac death (hazard ratio 3.74; 95% confidence interval 1.43–9.79, P = 0.007).ConclusionsIn initial‐dialysis patients, there is high agreement between the L1 and L3 measures for SMI and SMD. Low SMD measured at L1, but not low SMI, is an independent predictor of both all‐cause death and cardiac death.

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“…In patients with kidney dysfunction, such as HD patients, Cr would accumulate in the serum because of impaired Cr excretion from the kidney. Therefore, serum Cr levels could depend on individual muscle mass, and the serum Cr or Cr index would reportedly reflect muscle mass or sarcopenia, which involved lessened muscle mass or weakened muscle strength 32 , 33 . Furthermore, when patients have high muscle mass, blood volume into the muscle is high 34 .In HD patients at their forearm, an increase of muscle mass by hand exercise was associated with an increase in FV 35 , and less circulation into the muscle was related to low oxygenation 36 .…”

Section: Discussionmentioning

confidence: 99%

Effects of percutaneous transluminal angioplasty and associated factors in access hand oxygenation in patients undergoing hemodialysis

Sugiyama

K²,

Ookawara³

et al. 2023

Sci Rep

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In hemodialysis (HD) patients with arteriovenous fistula (AVF), changes in systemic or peripheral tissue circulation occur non-physiologically via the presence of AVF; however, associations between blood flow and tissue oxygenation in the brain and access hand are uncertain. In this study, 85 HD patients with AVF were included and evaluated for changes in flow volume (FV) and regional oxygen saturation (rSO2) in the brain and hands with AVF before and after percutaneous transluminal angioplasty (PTA). Furthermore, we evaluated the factors that determine access hand rSO2 without stenosis after PTA. Brachial arterial FV increased after PTA (p < 0.001), and carotid FV decreased (p = 0.008). Access hand rSO2 significantly decreased after PTA (p < 0.001), but cerebral rSO2 did not significantly change (p = 0.317). In multivariable linear regression analysis of factors associated with access hand rSO2, serum creatinine (standardized coefficient: 0.296) and hemoglobin (standardized coefficient: 0.249) were extracted as independent factors for access hand rSO2. In conclusion, a decrease in access hand oxygenation and maintenance of cerebral oxygenation were observed throughout PTA. To maintain access hand oxygenation, it is important to adequately manage Hb level and maintain muscle mass, in addition to having an AVF with appropriate blood flow.

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Muscle mass evaluation using psoas muscle mass index by computed tomography imaging in hemodialysis patients

Cited by 11 publications

References 19 publications

Association between the psoas muscle index and hospitalization for pneumonia in patients undergoing hemodialysis

Association between the psoas muscle index and hospitalization for pneumonia in patients undergoing hemodialysis

Computed tomography‐determined skeletal muscle density predicts 3‐year mortality in initial‐dialysis patients in China

Effects of percutaneous transluminal angioplasty and associated factors in access hand oxygenation in patients undergoing hemodialysis

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